Introduction
Haematuria refers to the presence of red blood cells into the urine, and
can be macroscopic or microscopic (Schumacher 2007). Specific data on
the incidence of haematuria in equine practice are lacking. However,
based on the available evidence, pathologic haematuria is considered
uncommon (Duesterdieck-Zellmer 2007; Smith et al. 2018). With
macroscopic haematuria, urine is red or brown. Discriminating haematuria
from pigmenturia (presence of haemoglobin, myoglobin, or pigments in
urine) may be challenging and requires laboratory analyses to be
performed (Delvescovo 2022). The most common problems associated with
haematuria are, in a putative order of frequency: urethral rents,
urethritis, urolithiasis, trauma and neoplastic masses, pyelonephritis,
cystitis, chronic administration of non-steroidal anti-inflammatory
drugs and clotting disorders. Urethral infestation by Habronema
spp. and Draschia spp. larvae, cantharidin toxicosis, renal
failure with intravascular haemolysis, and vascular anomalies are other
pathological conditions occasionally associated with haematuria
(Schumacher 2007). Primary haemorrhagic cystitis is a further idiopathic
condition resulting in haematuria. Exercise-related haematuria is also
repoted, most often microscopic in nature (Schott et al. 1995).
Bladder mucosa has a remarkable regenerative capacity which allows a
rapid return to urothelial integrity and function (Saulez et al.2005). Bladder haemorrhage often due to cystitis (either infectious,
inflammatory, or idiopathic), neoplasia, or trauma. Bacterial cystitis
requires mid- to long-term antibiotic treatment and might relapse,
depending on the inciting cause. In a previous report on idiopathic
haemorrhagic cystitis, most cases resolved completely or almost so in 3
weeks (Smith et al. 2018), following prolonged treatment with
antimicrobials and anti-inflammatory therapies, despite no bacteria were
cultured or identified. These data overall agree with experimental
evidence gathered in other species supporting a minimum of 4 weeks for
complete healing of damaged bladder mucosa (Hans et al. 2019). In
spite of the reported positive outcome of prolonged treatment, it is
sometimes advisable for the clinician to gain haemorrhage control
rapidly, because of the presence of significant anaemia, coagulation
disturbances, or because it might also reduce healing time and
antimicrobial treatment duration. Urothelium damage can in fact become
an entrance port for bacteria into the systemic circulation (Smithet al. 2018). On top of this, some horse owners have a strong
emotional attitude towards their animal, and will more easily accept
therapeutic interventions that control or at least improve the clinical
sign(s) for which they looked for veterinary attention in the
short-term, joined to other required long-term therapies effective for
treating the primary problem.
This report proposes an easy-to-apply topical treatment for rapid
bladder bleeding control in two adult geldings diagnosed with
haemorrhagic cystitis. The product used is a carboxymethyl-starch
powdera (CSP) employed in human surgery for blood loss
control (Bracey et al. 2017). Haemostatic supplements like the
one we describe were first used in human medicine in the 40’s, and since
then their efficacy has constantly improved (Vecchio et al.2016). To the best of the Authors’ knowledge, this is the first report
of trans-endoscopic or trans-catheter application of a haemostatic
powder in a hollow organ in equine practice.